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    System Analyst - Chicago, United States - Next Level Business Services, Inc.

    Next Level Business Services, Inc.
    Next Level Business Services, Inc. Chicago, United States

    3 weeks ago

    Default job background
    Description
    Configuration Architect for multi-state Medicaid, Marketplace, Medicare,Dual Eligible health plan. Supported plans full product portfolio related toFacets solution design and standards. Also represented Facets platform incoordination with solution architects across the plans entire enterprisesolution.
    Created and delivered end to end Facets based resource competencydevelopment program.
    Configuration automation and QA lead for regional Client Health Plan.

    Responsible for the development of Service Payment and Benefit automationutility solutionConfiguration Design Lead for implementation of State Exchange basedQHP product lineConfiguration Design Lead and Project Manager for Health Plan product lineexpansion into new Commercial and Medicaid lines of businessConfiguration design lead and team manager of Facets implementation andsystems conversion for large regional Client Health Plan.

    Included analystand design around Medical Plan, Provider/Network, Capitation, Billing,ASO, Workflow, Customer Service and Subscriber/MemberProject Manager over system conversion and Facets implementation ofmanaged Medicaid and Medicare product lines.

    Implementation and Configuration Lead (Provider, Plan/Product, Capitation,Billing, Claims, Utilization Management, NetworXPricer).SQL configuration-based scriptingConfiguration team trainingProject manager over successful Facets system release upgrade.

    Most Recent Engagement SummaryFacets Configuration Architecto Configuration Remediation Initiative Led effort to harvestbenefit configuration data from production system toidentify opportunities for improvement against newlydeveloped benefit code setso Developed program to extract all Facets configuration datainto usable format to support analysis of benefitsconfiguration.

    Solution allowed for the input of procedurecode and revenue code data to produce existingconfiguration reports across all conversion andsupplemental conversion tables.o Developed Architect Enhancement Review ProgramCreated and implemented new program to provide crosssolution review, solution, and approval with enhancementrequests.

    o Developed logic to extract Pre-authorization informationfrom Facets system to support Pre-Authorization reviewinitiative, and Provider PA Look-up tool


    o Developed configuration standards and new foundationconfiguration to support new business expansion and allowfor greater scalability and shared code sets between productlines.o Managed 20 staff configuration analysts in support ofBreak-Fix and Enhancement requests related to Facetsconfiguration.o Developed and implemented Facets Resource DevelopmentProgram.

    Program included assessment of staffconfiguration analyst and training on the entire core Facetssystem.o Lead configuration analyst in support of complexconfiguration requests, analysis and build.

    Role includedaddressing escalated issues and new configuration fromSenior Management.o Facets Configuration Design Lead for pilot fee-for-serviceMedicaid platform development.

    Led all aspects of globaldesign to support re-usable platform for multi-stateoffering.o Led the implementation of new Facets BPA supplementaldesign and build as part of ICD10 project.

    Solutionincluded the automated conversion of existing supplementalconfiguration into the BPA based design.

    "All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. NLB is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact HR department by sending an e-mail to "
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